Can Emotional Pain Cause Physical Pain? Why the Brain Turns On Pain for Danger, with Dr. Howard Schubiner (Part 1)
Yes. Emotional pain can cause physical pain, because the brain decides whether to turn on pain based on danger, and emotional danger counts as danger. Pain can appear with no injury at all when the brain senses a threat.
That matters most for people whose pain no test has explained. Many get a scan, and whatever it shows becomes the explanation, yet at age 60, 88% of people with no back pain at all already show disc degeneration on imaging. Chronic pain is one of the places stored trauma can show up in the body: a brain that learned danger early keeps protecting you from it.
Dr. Howard Schubiner is an internist, a Clinical Professor at the Michigan State University College of Human Medicine and the author of Unlearn Your Pain. He co-developed Emotional Awareness and Expression Therapy and co-authored the 2022 JAMA Psychiatry trial of pain reprocessing therapy.
This is Part 1 of a two-part conversation.
Chronic pain is one of the places stored trauma can show up in the body: the brain decides whether to produce pain based on the danger it senses, and emotional danger from childhood or from injustice counts. Dr. Schubiner calls brain-generated symptoms neuroplastic, meaning real, caused by the brain, and reversible. Even with rheumatoid arthritis, some of the pain can be neuroplastic.
CAN EMOTIONAL PAIN CAUSE PHYSICAL PAIN?
Yes. In Dr. Schubiner’s model, the brain treats emotional danger the way it treats physical danger, and pain is one of its responses to danger.
Dr. Schubiner starts with how much the brain filters. Billions of bits of light reach the eyes, and the brain decides what we actually see, which is why two people looking at the same thing can see something different. When we are injured, signals reach the brain, and the brain decides whether to turn on pain. “Not all pain is due to injury,” he says. “It’s our job to sort it out because emotional pain can cause physical pain, and that’s a fact.”
The research supports overlap and also adds a limit. Brain imaging finds that social rejection activates some of the same regions as physical pain. A later study found that the finer patterns of brain activity for the two are distinct. The overlap is real, and the two experiences are not identical in the brain.
HOW DOES A CHILDHOOD WITHOUT SAFETY BECOME PAIN LATER?
A child learns what is dangerous, and the brain keeps predicting that danger into adulthood. Even ordinary stress can then set off the warning signals.
Dr. Schubiner compares it to a bird that eats a red berry and gets sick. A child who is punished for speaking learns to stay quiet. A child surrounded by arguing learns to be the peacemaker, and that their own feelings come last. “So many people I’ve seen grow up feeling like they’ve been responsible for their parents’ mental health,” he says.
He describes a patient who was abused as a teenager and blamed when she told her parents. She learned that bad things would happen and that people could not be trusted. Over the years she developed back pain, headaches, stomach and pelvic pain, anxiety and fatigue. In his view, her brain was doing its job: sending warning signals because it still read the world as dangerous.
Danger signal: in Dr. Schubiner’s model, any input the brain reads as a threat, physical or emotional. Pain, anxiety and fatigue are among the brain’s responses to it.
CAN RACISM AND INJUSTICE CAUSE CHRONIC PAIN?
Dr. Schubiner argues they can contribute, because injustice leaves people feeling trapped and helpless, and the brain reads that as danger.
In 2023 Dr. Schubiner and colleagues published “Racism as a Source of Pain” in the Journal of General Internal Medicine. He points to data showing higher rates and greater severity of pain among people from minority groups, people living in poverty and less educated people. He is careful about what it can prove: “It’s hard to prove in any one person” what the overall cause is.
Dr. Aimie names what the brain is looking for: “We’re looking for that safety net, aren’t we? Like the brain is searching for: Am I safe? Am I safe enough?”
WHY ARE CHRONIC PAIN, FATIGUE AND POTS BECOMING MORE COMMON?
Dr. Schubiner says no one can say for sure, but he points to a world that has become more frightening while the body has stayed the same. “Our backs haven’t changed,” he says. “Evolution doesn’t happen that fast.”
Dr. Schubiner points to rising fear, competition, inequality, polarization and online bullying. He sees the increases mostly in people in their teens through their forties, and in women, who face higher rates of emotional abuse, sexual assault, intimate partner violence and workplace harassment, along with caregiving for two generations. National survey data agree that chronic pain is more common among women and adults living in poverty. Overall, chronic pain is also more common with age; his point is about where the recent increases are concentrated.
Medicine, meanwhile, keeps searching for a biomedical cause for POTS, chronic fatigue, long COVID and chronic Lyme, and often cannot find one. Dr. Schubiner argues that alternative medicine can also send the message that people are physiologically broken and need many costly treatments. Either way, people can feel trapped in a body they believe is damaged and broken, when they may have a neuroplastic condition.
IS PAIN THAT COMES FROM THE BRAIN REAL?
Yes. Dr. Schubiner is direct that symptoms the brain generates are real, and that they are reversible. He calls them neuroplastic.
Dr. Schubiner lists fibromyalgia, migraine and tension headaches, most chronic back pain, pelvic pain and IBS, and says he has had most of them himself. His message is that the question deserves to be asked: “at least we should ask the question.” Part 2 continues the conversation.
Neuroplastic pain: pain generated by the brain, as Dr. Schubiner uses the term. The symptoms are real, caused by the brain, and reversible.
CAN RHEUMATOID ARTHRITIS PAIN BE NEUROPLASTIC?
Some of it can. Dr. Schubiner puts rheumatoid arthritis in the middle: a real inflammatory condition that can damage joints, plus a neuroplastic component in some people.
Dr. Schubiner starts with a detailed life history and a careful medical evaluation. Fibromyalgia, migraine and irritable bowel are almost always neuroplastic in his experience. Rheumatoid arthritis responds well to anti-inflammatory and newer medications, though not perfectly. Some people also have neuroplastic pain on top of it, sometimes in other places, and that pain can persist or spread even when the medication controls the arthritis.
His answer for people with both: “So sometimes we can use medications plus neuroplastic type brain training treatment and dealing with emotional trauma as we do to treat the neuroplastic components. So you can have both.”
CAN THE BRAIN CONTROL INFLAMMATION?
Yes, in part. Dr. Schubiner points to psychoneuroimmunology, the field that studies how the brain and immune system influence each other.
Dr. Schubiner has seen people with rheumatoid arthritis, Crohn’s disease, ulcerative colitis and asthma improve, sometimes dramatically, with mind-body work, and he describes these cases in his new book, Unlearn Your Pain. These are clinical
observations. He is clear that medication still has a place: “[there’s] nothing wrong with using medications but mind-body work or neuroplasticity recovery treatments can also be quite effective in those conditions.” Nothing in this episode is a recommendation to change or stop a medication.
Psychoneuroimmunology: the study of how the brain, nervous system and immune system affect one another, including how stress and emotion shape inflammation.
Key Takeaways
Emotional pain can cause physical pain. The brain decides whether to turn on pain based on danger, and emotional danger counts.
Not every injury causes pain, and pain can appear without an injury.
Social pain and physical pain overlap in the brain, though their finer activity patterns differ.
Childhood teaches the brain what danger looks like, and it keeps predicting that danger in adulthood.
Dr. Schubiner argues that racism and injustice leave people feeling trapped and helpless, which the brain reads as danger.
Dr. Schubiner links the rise in chronic pain, fatigue and POTS to a more frightening world, since the body itself has not changed.
In Dr. Schubiner’s view, neuroplastic symptoms are real, caused by the brain, and reversible.
Structural disease and neuroplastic pain can coexist, so treatment can address both.
The brain influences inflammation, the subject of psychoneuroimmunology.
Notable Quotes
“Not all pain is due to injury. It’s our job to sort it out because emotional pain can cause physical pain, and that’s a fact and that’s how we’re wired.” ~ Dr. Howard Schubiner
“We learn by experiences, positive experiences, but we really learn by negative experiences.” ~ Dr. Howard Schubiner
“So many people I’ve seen grow up feeling like they’ve been responsible for their parents’ mental health.” ~ Dr. Howard Schubiner
“The brain tries to alert us when we’re in danger, and if it’s emotional danger, it’s still danger.” ~ Dr. Howard Schubiner
“Injustice leads people to feel trapped… helpless.” ~ Dr. Howard Schubiner
“We’re looking for that safety net. The brain is searching for: Am I safe? Am I safe enough?” ~ Dr. Aimie Apigian
“Our brain only has certain things it can do when there’s danger. And [one] of those is cause pain.” ~ Dr. Howard Schubiner
“We get to ask better questions… better questions to ask themselves, as well as better questions to ask their providers.” ~ Dr. Aimie Apigian
“So sometimes we can use medications plus neuroplastic type brain training treatment and dealing with emotional trauma… So you can have both.” ~ Dr. Howard Schubiner
Episode Takeaway
Chronic pain is one of the places where I see the biology of trauma most clearly. It is also one of the places where people are most often dismissed. They are told the pain does not make sense, or that it comes from whatever showed up on a test, and they are treated for that alone.
I wanted Dr. Schubiner back on the podcast because his answer to “why does it hurt?” starts somewhere different. The brain decides whether to turn on pain, and it decides based on danger. Not every injury causes pain. Pain can appear without an injury. And emotional danger is still danger.
That last point is the one I most want you to hold. When a child learns that speaking up gets them punished, or that keeping everyone else calm matters more than their own feelings, the brain learns what danger looks like. It keeps predicting that danger long after childhood ends. Then the ordinary stresses of adult life can set off the same warning signals: pain, headaches, stomach symptoms, anxiety, fatigue. The body learned danger early and has been protecting you from it ever since.
Dr. Schubiner widens the lens beyond family. Injustice, racism and the absence of a safety net also register as danger. The brain is always asking: am I safe? Am I safe enough? When the resources are not there, socially, financially or politically, the answer can stay no for years.
He and I come at this from different models, and I think the differences are useful. Where we meet is here: we both see a body that learned danger early and kept protecting you from it, and pain that can change when the nervous system receives new data.
That is why I appreciate his insistence that these symptoms are real and reversible. And a diagnosis does not close the question. Someone with rheumatoid arthritis can have real inflammation and also pain that the brain is generating on top of it. Both deserve attention. Even inflammation itself is shaped in part by the brain.
So the invitation of this episode is to ask better questions. Better questions of yourself: when did this pain start, what was happening in my life, what did my body learn about danger? And better questions of your providers: could part of this be my nervous system protecting me?
In the Biology of Trauma® framework, we work in an order: safety first, then building capacity, then opening what has been stored. For pain that began as protection, that order matters. The body does not let go of a protective response until it has enough evidence that it is safe to.
In Part 2, Dr. Schubiner and I talk about what changes when emotions held down for decades are finally expressed, and where to start when your capacity is very low.
If you recognize yourself here, the 2-Minute Assessment for Stored Trauma will help you see which patterns of stored trauma are most active in your body. And when you are ready to build the safety and capacity the rest of the work depends on, the Foundational Journey is where that work begins.
Frequently Asked Questions
Can emotional pain cause physical pain?
Yes. The brain decides whether to produce pain based on the danger it senses, and emotional danger counts as danger. Dr. Howard Schubiner calls this a fact of how we are wired.
Can you have pain without an injury?
Yes. Dr. Schubiner explains that not every injury causes pain, and pain can appear with no injury at all when the brain experiences danger.
Can childhood trauma cause chronic pain in adulthood?
Dr. Schubiner sees this often. A child learns what is dangerous, the brain keeps predicting that danger, and later stress can set off pain, headaches, gut symptoms, anxiety and fatigue.
Why is chronic pain more common in women?
Dr. Schubiner points to experiences women face at higher rates, including emotional abuse, sexual assault, intimate partner violence, workplace harassment and caring for two generations at once. He allows that hormones and the immune system may also play a part.
Is pain that comes from the brain real?
Yes. Dr. Schubiner describes neuroplastic symptoms as real, caused by the brain, and reversible. Fibromyalgia, migraine, tension headaches and most chronic back pain fall in this group in his experience.
Can you have rheumatoid arthritis and neuroplastic pain at the same time?
Yes. Rheumatoid arthritis involves real inflammation and joint damage, and some people also have neuroplastic pain on top of it. Dr. Schubiner sometimes treats both: medication for the arthritis and brain-based treatment for the neuroplastic part.
Can the brain affect inflammation?
Yes. The field of psychoneuroimmunology studies how the brain and immune system influence each other. Dr. Schubiner has seen people with autoimmune conditions improve, sometimes dramatically, with mind-body work. He also says there is nothing wrong with using medications.
In This Episode
00:00 Introduction
02:02 How the Brain Decides to Create Pain
04:23 How Childhood Teaches the Brain Danger
07:32 Racism, Injustice, and Pain
10:08 Why Pain, Fatigue, and Long COVID Are Rising
14:37 Rheumatoid Arthritis and Neuroplastic Pain
18:27 Closing Reflections and Part Two Preview
Resources and Guides
Take the free 2-Minute Assessment for Stored Trauma. See which patterns of stored trauma are most active in your body. 2-Minute Assessment for Stored Trauma
Get The Biology of Trauma book.
Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression by Dr. Howard Schubiner.
Your Host
Dr. Aimie Apigian, MD, MS, MPH is a double board-certified physician in preventive medicine and addiction medicine with master's degrees in biochemistry and public health. She is the author of The Biology of Trauma, the founder of Trauma Healing Accelerated, and the creator of the Biology of Trauma® framework. She guides self-help individuals and trains practitioners in safely opening up stored trauma that has become biology. Her work came out of her own experience of being a physician with stored trauma she did not recognize as trauma.
About the Guest
Dr. Howard Schubiner is an internist and a Clinical Professor at the Michigan State University College of Human Medicine. He founded the Mind Body Medicine Program at Providence Hospital in Southfield, Michigan, and now sees patients through Cormendi Health. With Dr. Mark Lumley he co-developed Emotional Awareness and Expression Therapy, and he co-authored the 2022 JAMA Psychiatry trial of pain reprocessing therapy for chronic back pain. He is the author of Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression.
Related Episodes
For the listener ready for what to do: what changes when long-held emotions are finally expressed, and where to start when capacity is low.
Episode 91: The Neuroscience of Chronic Pain: How Our Brain Predicts And Creates A Biology of Pain with Dr. Howard Schubiner. For the listener who wants the neuroscience: how the brain predicts pain and makes it habitual.
Episode 166: The Body Can’t Heal Pain It Still Perceives as a Threat. For the listener who wants Dr. Aimie’s framework: the critical line of overwhelm and the five nervous system skills that build capacity.
Research
Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An fMRI study of social exclusion. Science. 2003;302(5643):290-292. Social rejection activated brain regions also involved in physical pain.
Woo CW, Koban L, Kross E, et al. Separate neural representations for physical pain and social rejection. Nat Commun. 2014;5:5380. The finer patterns of activity for the two differ, a limit on the overlap.
Schubiner H, Jackson B, Molina KM, et al. Racism as a source of pain. J Gen Intern Med. 2023. The paper Dr. Schubiner describes in this episode.
Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults, United States, 2016. MMWR. 2018;67(36):1001-1006. National data on who carries chronic pain.
Ashar YK, Gordon A, Schubiner H, et al. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain. JAMA Psychiatry. 2022;79(1):13-23. Randomized trial of a brain-focused treatment for chronic back pain, co-authored by Dr. Schubiner.
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. Source of the disc degeneration figure in the opening.
Transcript
Disclaimer
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